Medical Assistance under the TEFRA Option

2.3.6.1.1 Applications

Medical Assistance (MA) under the TEFRA option is for children with a disability who are otherwise ineligible for MA because household income is above the MA for Families with Children and Adults (MA-FCA) income limit. The TEFRA option for children with a disability is named after the Tax Equity and Fiscal Responsibility Act (TEFRA) of 1982 that created the option.

Because the MA under the TEFRA option is only available to children with a disability who are not eligible because household income is above the MA for Families with Children and Adults (MA-FCA) income limit, children must first apply for MA using the MNsure online application or the paper MNsure Application for Health Coverage and Help Paying Costs (DHS-6696).

A determination must be made for MA under the TEFRA option when MA is denied because the household income exceeds the child’s income limit, and the child has a certified disability or a condition that may qualify as a disability.

The county or tribal agency will use the information provided on the DHS-6696 application and request any additional information or verifications as needed to determine eligibility for MA under the TEFRA option.

The county, tribal or state servicing agency must complete a State Medical Review Team (SMRT) referral, evenwhen the person is approved for Social Security, to make a level of care determination. See the MA-ABD Certification of Disability policy and TEFRA Level of Care policy for more information.

Legal Citations

Code of Federal Regulations, title 42, section 435.225

Code of Federal Regulations, title 42, section 435.907

Code of Federal Regulations, title 45, section 155.405

Code of Federal Regulations, title 45, section 155.310

Minnesota Statutes, section 256B.08

Minnesota Statutes, section 256B.055, subdivision 12

The Tax Equity and Fiscal Responsibility Act (TEFRA), Public Law 97-248, section 134

United States Code, title 42, section 1396a, subdivision e